Weinberg L A
J Prosthet Dent. 1976 Oct;36(4):426-40. doi: 10.1016/0022-3913(76)90167-0.
One type of condylar displacement (posterior bilateral) was discussed as an etiologic factor in TMJ dysfunction. Joint noise, tenderness on muscle palpation, and acute TMJ pain are all considered signs of TMJ dysfunction. Any joint noise is considered to be an early dysfunctional symptom because of its higher incidence in association with palpable muscle pain or acute TMJ dysfunction. Sometimes the joint noise will immediately precede acute muscle pain and/or fluctuate with the painful symptoms. The treatment of bilateral posterior condyle displacement has been described. The mandibular anterior teeth were shortened and the maxillary posterior occlusion adjusted so that the mandible could be respositioned in an anterior position without increasing the vertical dimension of occlusion. A silver-plated maxillary cast was obtained and mounted on a semiadjustable articulator (Hanau) with a face-bow. The mandibular cast was mounted in the dysfunctional (retruded) centric relation. The articulator was moved into a protrusive position by the amount of anterior correction that is needed to reposition the condyles into the middle of the fossae symmetrically on both sides. The original TMJ radiographs provide the necessary information for this clinical judgment. Acrylic resin was placed in the space created between the condylar sphere and stop on the articulator. An acrylic resin temporary repositioning prosthesis constructed on the metal cast has two functions. It provides a therapeutic trial for the anterior condylar respositioning, and it holds the mandible in the therapeutic position while TMJ radiographs confirm the corrective position of the condyles in the fossae. After a successful 6 to 8 week trial period with remission of symptoms, a gold prosthesis was constructed on the same cast in the same therapeutic position. It remains to be seen whether, after several years, the condylar suspension system changes from a dysfunctional centric relation to a new functional centric relation in which the patient can no longer return to the posterior displaced condylar position in the fossa. Only with painstaking observations, accurate TMJ radiographs, complete documentation, and after-care can a more scientific approach to the diagnosis and treatment of TMJ dysfunctional pain syndrome be achieved.
一种髁突移位类型（双侧后移位）被认为是颞下颌关节功能紊乱的一个病因。关节弹响、肌肉触诊压痛以及急性颞下颌关节疼痛均被视为颞下颌关节功能紊乱的体征。任何关节弹响都被认为是早期功能紊乱症状，因为它在伴有可触及的肌肉疼痛或急性颞下颌关节功能紊乱时发生率更高。有时关节弹响会紧接急性肌肉疼痛之前出现和/或随疼痛症状波动。双侧后髁突移位的治疗方法已被描述。下颌前牙被磨短，上颌后牙咬合进行调整，以便在下颌不增加垂直咬合高度的情况下向前重新定位。获取一个镀银的上颌模型，并使用面弓安装在半可调式牙合架（Hanau）上。下颌模型安装在功能紊乱（后缩）的正中关系位。通过将髁突对称地重新定位到关节窝中部所需的前伸矫正量，将牙合架移动到前伸位置。原始的颞下颌关节X线片为这一临床判断提供必要信息。在髁突球与牙合架上的定位器之间形成的间隙中放置丙烯酸树脂。在金属模型上制作的丙烯酸树脂临时重新定位修复体有两个功能。它为髁突向前重新定位提供治疗性试验，并且在颞下颌关节X线片确认髁突在关节窝中的矫正位置时，将下颌保持在治疗位置。在经过6至8周成功的试验期且症状缓解后，在同一模型上、同一治疗位置制作金修复体。数年之后，髁突悬吊系统是否会从功能紊乱的正中关系转变为一种新的功能正中关系，即患者无法再回到关节窝中髁突后移位的位置，还有待观察。只有通过细致的观察、精确的颞下颌关节X线片、完整的记录以及后续护理，才能实现对颞下颌关节功能紊乱疼痛综合征更科学的诊断和治疗方法。
